黑色素瘤

最后审阅: 8 一月 2023
最后更新: 10 八月 2022

小结

定义

病史和体格检查

关键诊断因素

  • 有变化的色素性皮损(ABCDE指征)
  • 黑素细胞性皮损不像其周围的黑素细胞痣(“丑小鸭”现象)
  • 色素性皮损自发出血或溃疡
  • 全身性症状
  • 甲征象:单一指(趾)甲出现持续性纵行黑甲
  • 甲征象:Hutchinson 征
  • 非典型的皮肤镜发现
  • 固定肿大的淋巴结
  • 在途转移
更多 关键诊断因素

危险因素

  • 黑色素瘤家族史
  • 具有黑素瘤个人史
  • 个人皮肤癌病史(包括光化损伤)
  • 非典型痣的病史
  • Fitzpatrick Ⅰ 型或 Ⅱ 型皮肤(白色皮肤)
  • 红色或金色头发
  • 高密度的雀斑
  • 光暴露
  • 日光浴的使用
  • 浅色眼睛
  • 良性黑素细胞痣数量的增加
  • 巨大型先天性痣
  • 免疫抑制
  • 着色性干皮病
更多 危险因素

诊断性检查

首要检查

  • 皮肤镜检查
  • 皮肤活检
  • 免疫组织化学检查
更多 首要检查

需考虑的检查

  • 前哨淋巴结活检
  • 胸、腹、盆腔CT扫描
  • 全身 PET 扫描
  • 脑影像学检查(CT 或 MRI)
  • BRAF突变分析
  • NRAS 突变分析
  • 血清乳酸脱氢酶
更多 需考虑的检查

新兴检查

  • CDKN2A 突变分析

治疗流程

急症处理

早期黑色素瘤(原位黑色素瘤、Ⅰ 期、Ⅱ 期)

可切除的晚期黑色素瘤(Ⅲ 期和 Ⅳ 期)

不可切除的晚期疾病(Ⅲ 期和 Ⅳ 期)

撰稿人

作者

Prachi Bhave, BE (Hons), MBBS, FRACP

Medical Oncologist

Peter MacCallum Cancer Centre

Victoria

Australia

利益声明

PB has received honoraria from Novartis and sponsorship from MSD and Novartis.

Yin Wu, MRCP, PhD

Wellcome Trust Clinical Research Career Development Fellow and Honorary Consultant Medical Oncologist

Peter Gorer Department of Immunobiology

King's College London

Department of Medical Oncology

Guy's and St Thomas' NHS Foundation Trust

London

UK

利益声明

YW is funded by the Wellcome Trust.

Pablo Fernandez-Peñas, MD, PhD, FACD

Associate Professor of Dermatology

The University of Sydney

Sydney

Australia

利益声明

PF-P declares that he has no competing interests with the topic Melanoma. PF-P has advisory roles with Amgen, Boehringer Ingelheim, Bristol Meyers Squibb, Leo, Novartis, Lilly, Abbvie, Janssen, Celgene (psoriasis, atopic eczema, hidradenitis), Roche, Merck Sharp & Dohme, Sun Pharmaceuticals, Novartis, and Sanofi. He has been paid to do research for Incyte Europe Sarl, and clinical trials for Arena, Akaal Pharma, Xoma, Kyowa Hakko Kirin, AbbVie, OncoSec, Lilly, CSL Behring, Boehringer Ingelheim, Pfizer, mRage, Eisai, Jiansu Hengrui, Bristol-Myers Squibb, Sun Pharma, Novartis, Roche, Galderma, Regeneron, UCB, GlaxoSmithKline, and Amgen.

鸣谢

Dr Prachi Bhave, Dr Yin Wu, and Dr Pablo Fernandez-Peñas would like to gratefully acknowledge Dr Robyn P.M. Saw, Dr Sophie E. Papa, Dr Alexander M. Menzies, Dr Philip Friedlander, Dr Hobart W. Walling, and Dr Brian L. Swick, previous contributors to this topic.

利益声明

RPMS is on the advisory board for Novartis, MSD, and Qbiotics and has previously been on the advisory board for Amgen; he has received honoraria from BMS and Novartis. SEP has received honoraria from BMS, MSD, and Novartis to attend conferences; she has participated in advisory boards for BMS, MSD, Amgen, Roche, and GSK. AMM has received honoraria from Novartis and BMS; he is on the advisory boards of MSD and Chugai. PF is a consultant for Genentech. HWW and BLS declare that they have no competing interests.

同行评议者

David Cassarino, MD, PhD

Assistant Professor

Department of Pathology and Laboratory Medicine

University of California

Los Angeles

CA

利益声明

DC declares that he has no competing interests.

James DeBloom, MD

Dermatologist/Dermatologic Surgeon

President of the South Carolina Skin Cancer Center

Greenville

SC

利益声明

JB declares that he has no competing interests.

Mai Brooks, MD, FACS

Associate Director

JCCC Women's Cancers Program Area

Jonsson Comprehensive Cancer Center at UCLA

Los Angeles

CA

利益声明

MB declares that she has no competing interests.

Karol Sikora, MA, MBBCh, PhD, FRCR, FRCP, FFPM

Medical Director

CancerPartnersUK

London

UK

利益声明

KS declares that he has no competing interests.

  • 黑色素瘤 images
  • 鉴别诊断

    • 良性/发育不良的黑素细胞痣
    • 脂溢性角化病
    • 色素性基底细胞癌
    更多 鉴别诊断
  • 指南

    • 黑色素瘤的全身性治疗
    • 脑转移的治疗
    更多 指南
  • 患者教育信息

    皮肤癌(黑色素瘤):如何定义?

    皮肤癌(黑色素瘤):如何诊断和治疗?

    更多 患者教育信息
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